unit 3 Flashcards
1
Q
What steps can be taken to achieve a healthy start before pregnancy
A
healthy weight, adequate diet, being active, check-ups, managing chronic illnesses, avoiding harmful substances
2
Q
what is a critical period of development in pregnancy
A
intense stage of rapid cell division
3
Q
What are two spinal tube defects
A
Spina Bifida, anencephaly
4
Q
what is spina bifida
A
the tube is not completely closes
5
Q
what is anencephaly
A
the brain isn’t dvlpted
6
Q
what are some risk factors in neural tube defects
A
family history, maternal diabetes, folate deficiency, maternal obesity, medicine
7
Q
what can alter gene expression and lead to chronic diseases in adulthood
A
fetal programming
8
Q
fetal and maternal health depends on this
A
weight gain during pregnancy
9
Q
weight gain during pregnancy is correlated with what
A
birth weight and is a predictor of health
10
Q
weight gain during pregnancy depends on what 2 things
A
number of fetuses, and pre-pregnancy weight
11
Q
Normal weight gain is how many lbs
A
25-35 lbs
12
Q
is there an increased energy need in the first trimester
A
There is no increased need but there is a weight gain of 3-5 lbs
13
Q
increased energy need in the second trimester
A
340 kcals with a gain of 1lbs a week
14
Q
increased need in the third trimester
A
450 kcals and a gain of 1lbs a week
15
Q
CHO importance in pregnancy
A
increased need for fetus brain fuel
16
Q
PRO importance in pregnancy
A
increased need by 25 g a day
17
Q
FAT importance in pregnancy
A
increased need for EFA for brain development
18
Q
importance of iron in pregnancy
A
baby is taking moms store of iron so there is
19
Q
High-risk pregnancy factors
A
low birth weight, gestational age, maternal concerns, glucose mishandling, hypertensive d/o, preeclampsia, eclampsia
20
Q
what is considered a low birth rate and what is this related to
A
5.5 lbs or less and there is a relationship with SES
21
Q
gestational age risk to pregnancy
A
baby can be born preterm and if the baby is small they can make up the weight
22
Q
maternal concerns in risk factors fro pregnancy
A
malnutrition in early and late pregnancy
23
Q
effects of malnutrition in early pregnancy
A
placenta defects or lack of growth/nutrients
24
Q
effects of malnutrition in late pregnancy
A
effects of fetal dvlpt
25
glucose mishandling factors and risk
worried about pre-existing diabetes, gestational diabetes
26
what is gestational diabetes
diabetes dvlpt during pregnancy - includes macrosomia
27
what is macrosomia in gestation diabetes
The baby is taking all glucose and the baby weight is increases
28
hypertensive disorder in pregnancy
increases blood pressure and puts mom and fetus at risk
29
gestations hypertensive disorder
high blood pressure dvlp during pregnancy in 2 trimesters and will go back to normal after birth
30
what is preeclampsia
high BP, as well as protein in urine,
| can lead to decreased fetal growth and miscarriage
31
what is eclampsia
sudden seizure/ coma
32
what factors are affected in maternal age
there is a risk if mom is 35 or older,
33
what are three factors in infancy growth
weight, length, growth (length-weight, head circumference)
34
what is the energy need of an infant compared to an adult
2x the adult need
35
where do most nutrients come from birth - 6 month
breast milk
36
where do most nutrients come from while 6-12 mon
breastmilk and complementary foods
37
affects of CHO in infants
relative to brain size and is about 12% body weight
38
affects of PRO in infants
limited due to immature kidneys and liver
39
affects of vitmains and minerals in infancy
twice the adult need -- vit k supplement shots and vit D for breast fed infants
40
h20 needs in infants
most water is extracellular so there is higher dehydration risk- needs are met by breast milk
41
what is the majority of nutrients in breast milk q
majority fat then carbs, the smallest amount is protein
42
what are some advantages to breast milk
immunological protection, sterile at room temp for 6-8 hours, and colostrum, bifidus factor, decreases allergies, lower cost, weight loss in mom
43
what is the Bifidus factor
increase growth of lactobacillus --
44
importance of lactobacililus
jumpstarts microbiome
45
what is a con of iron-fortified formula milk
no protective ability- lacks immune benefits and antibodies from breastmilk
need safe water and ensure mixed fully,
46
how often do infants eat breast milk
every 2/3 hours and increased time between
47
how to prevent nursing bottle decay
never put baby to bed with a bottle
48
what is nursing bottle decay
tooth decay by cho in the mouth when dipping milk - acid secreted to damage teeth
49
when is a child allowed to eat solids
after 6 months or ready
50
readiness to eat solid
able to hold up the head, and swallow reflex defined
51
purpose of solids in eating
provide nutrients not adequately provided in breast milk
52
how to introduce new foods
one at a time, every 3/5 days before new food to check allergies.
53
etiquette for childhood eating
1+ year eating at the table, drinking from a cup, more adult foods.
54
in childhood what changes
body comp and shape changes increase muscle growth
55
what happens in children's appetite at 1 year
appetite decreases after 1 yeat
56
effects of sugar on behavior
doesnt cause hyperactivity-caused more by events surrounding intake
57
ADHD and additives and behavior
not universal but some coloring and preservatives
58
Fe deficiency can affect...
attention span, and intellectual performance
59
effects of skipping breakfast
leads to decreased attention span, apathy, shorter attention school,
60
childhood obesity is
on the rise- 1/4 of kids
61
obesity is based on BMI in the what percentile
95-97
62
what are the consequences of obesity
impact on growth, physical health ( CDC risk, HTN, type 2 diabetes), physiological health, leads to adult obesity
63
nutrient concerns with older adults
physiological age ( activity and health) vs chronological age
64
body weight in older adults,
moderate weight not associated with health risks,
65
body comp changes in older adults
decrease in LBM, sarcopenia (decrease muscle mass, adn strength), osteoporosis, risk of obesity,
66
prevention of obesity
physical activity, adequate nutriton esp protein
67
nutritional concerns in older adults,
decrease the immune system, inflammation, deficiencies, decrease gi function, dysphagia, tooth loss,
68
energy needs in older adults
decrease in energy need, -- the importance of energy-dense food,
69
protein use in older adults
fighting infection
70
Cho use in older adults
fiber
71
water in older adults
thirst response, dehydration in UTI, pneumonia, confusion
72
b12 in older adults
atrophic gastritis - can have intramuscular injections
73
folate in older adults
interferes with folate metabolism
74
vit D in older adults
supplements necessary because skin loses abilty to synthesize, and kidney loses abilty to activate
75
Ca in older adults
suboptimal in dairy intake
76
what is malnutrition
any condition caused by excess or decency of food energy or other nutrients by an imbalance of nutrients
77
causes of malnutrition
decreased dietary intake, increased requirements, impaired absorption, altered nutrient intuition
78
history involved in screening and assessment
med history, meds and supplements, personal/socail history, food
79
4 types of intake data
24 hour recall, food frequancy, food record, observation
80
anthropometric data
height, weight, head-circumference (babies), muscle/fat amounts
81
biochemical data
urine blood test
82
using weight involves
current weight, usual weight, BMI, ideal weight, percent weight loss, fluid retention
83
%usual body weight
usual BW/ ideal BW x100
84
%ideal body weight
amt weight loss/ usual weight x100
85
who is at risk for malnutrition
if weight loss is 10% in 6 mont involuntarily, BMI less than 18.5 or greater than 25
86
effects of protein malnutritions
high risk or ulcers, decreases wound healing, higher infection are, extended hospital stay
87
what is etiology based malnutrition
seeing where malnutrition is coming from
88
identification of malnutrition
use of docs, nurses, dietitians, asses within 24 hours of hospitalization
89
what standardizations are in place when identifying malnutrition
AND/ASPEN - clinical char that the dietician can obtain and document to support a diagnosis of malnutrition
90
what are some clinical characteristics
insufficient energy intake, weight loss, loss of body fat and muscle mass. fluid accumulation, reduced grip strength.
91
why would you modify a diet
for consistency, transition for other parenteral nutrition, before or after procedures, nutrient modification
92
what are some liquid diet options
water, coffee, tea,( nothing added) fat-free broth, popsicles, gelatin, sports drinks, no pulp lemonade,
93
what are some texture modifications
Pureed ed food - completly smooth. (c)
mechanical soft - mashed ground, minced (b)
soft- moist soft texture (a)
94
what are some strategies for meeting nutrition needs
liquid energy supplements, drinking calories, milkshakes,
| instant breakfast smoothies, protein bar, boost, ensure
95
Enteral nutrition
aka tube feeding- used the GI and gut
96
Cons to enteral nutrition
expensive, stressful, complicated
97
How are enteral tubes inserted
gastronomy, jejunostomy, nasogastric (short term), stoma opening
98
cons to a tube feeding tube
GI bleeding, high output fistulas, uncontrollable vomiting
| or diarrhea, intestinal obstruction, severe malabsorption,
99
who can have tube feeding
indi with swallowing d/o, upper GI motility issues
GI obstruction, ventilator, higher nutrient requirements,
poor appetite, altered mental status
100
what is reliant on formula selection
```
nutrient/ energy levels, fluid requirement, osmolarity, fiber need,
individual tolerance (allergies, sensative)
```
101
what are the 4 types of formula
standard, elemental, specialized formula, modular
102
what is a standard formula
commercial blenderized formula
103
what is an elemental formula
CHO and PRO are partially or fully hydrolyzed
104
what is a specialized formula
specific formula and is specific for diseases
105
what is a modular formula
contains a single macronutrient
106
Bolus feeding
large volume by syringe every 3-4 hrs
| only into stomach
107
intermediate feeding
infused over 30-45 minutes, requires more equipment, and is tolerated into the stomach
108
Continuous feeding
slow and consistency (8-24hrs). tolerated into the stomach and small intestine
109
Transition to oral intake
gradually off tube while oral intake increases must come 2/3 nutrients by mouth, may continue at home,
110
parenteral nutrition
based on appetite, GI function, and length of need
111
who can have parenteral nutrition
severe GI bleeding, high fistula output, uncontrollable vomiting and diarrhea, intestinal block, severe malabsorption, paralytic ileus
112
When is Parenteral nutrition not used
if the patient is well nourished and not able to eat for 7 days
113
PPN
peripheral parenteral nutrition - used peripheral veins,
114
TPN
total parenteral nutrition - catheter inserted and close to the heart
115
characteristics of PPN
short term less than 2 weeks, limited nutrient supply due to blood flow dilution
116
characteristics of TPN
central veins, long term, grtr nutrient concentration, best for those with fluid restrictions,
117
PRO Parenteral solution
amino acids
118
CHO in the parenteral solution
glucose into dextrose supplies energy and complete breakdown,
119
Lipid emulsions in parenteral solutions
supplies EFA plus energy, need an emulsifier to keep in suspension
120
fluid and electrolytes in parenteral solutions
adjust to the patient need for fluid, electrolytes, acid/base balance,
121
how long are you on parenteral nutrition
can be continued for critically ill, cyclic infusion for longterm and gives more freedom for 8-14 hrs infusion
122
steps to discontinue parenteral nutrition
adequate GI function, minimal aspiration risk, lower appetite issues, 2/3 nutrients met by other means,
123
complication wit TPN
hyperglycemia, hypoglycemia, hypotriglyceridemia, Refeeding syndrome, lie disease, gallbladder disease, metabolic bones disease, infection
124
what is refeeding syndrome
the result from hormonal and metabolic changes associated with starvation should start feeding slowing
125
what happens in refeeding syndrome when food is first given
increase in...blood glucose, insulin, and anabolic occurrence- creates an electrolyte imbalance
126
what are some disorders of the upper GI
dry mouth, mouth ulcers, difficulty chewing, dysphagia
127
treatments to dry mouth
salvia substitutes
128
dietary help to dry mouth
lemon drops, sugarless gum, moist, soft foods, drinking water, need proper oral hygiene.
129
what are mouth ulcers
lesions or sores inlining of mouth,
130
dietary interventions to mouth ulcers
decreased spicy, salty, and acidic foods, softer texture, cold food, and drinks.
131
reasons for chewing difficulty
problems with teeth or lack of them, mouth surgery
132
dietary intervention to chewing difficulty
consistences change in food texture
133
dysphagia
difficulty swallowing
134
oropharyngeal phase
involves mouth and pharynx - - inability to get food to the back of the throat into the esophagus
135
reasons for oropharyngeal phase s
Alzheimer's, Lou Gerig's disease, MS, Parkinson's disease, stroke
136
esophageal phase
feels like something stuck in the esophagus
137
esophagus phase reasons
peristalsis d/o with food and water
| smaller esophagus: just-food
138
complications with esophageal phase
aspiration, malnutrition, weight loss, risk of dehydration,
139
diets to help with the esophageal phase
consider what an individual can tolerate,
140
diets for esophageal phase
clear liquid, full liquid, pureed, mechsoft, soft can also thicken the liquid
141
IDDSI made what
descriptions and food classification
142
Gastroesophegeal reflux disease
backflow of gastric contenets into esophus
143
consequences of GERD
damage esophagus, esophagus ulcers, esophageal structure (narrowing) and can lead to dysphagia,
144
barrets esophageal
is a cellular shift occasional heartburn, higher risk of esophageal cancer
145
risk factors to GERD
obesity, and extra pressure on the stomach, pregnancy and hormonal changes, hiatal hernia ( above the diaphragm and pushes esophagus), meds
146
managment of GERD
meds, diet changes, lifestyle changes, surgery if serious
147
diet for GERD
avoid foods that relax lower esophagus sphincter
148
lifestyle modification in GERD
loss of weight, wear loose-fitting clothes, avoid over eating, consume small meals, remain elevated b4 and after eating, quit smoking and don't costume anything before bed,
149
Peptic Ulcers
feels like a knowing pain and goes and comes while eating,
| occurs in the upper duodenum and somatic.
150
reasons for Peptic Ulcers
h pylori, NSAIDS (anti-inflammatory), smoking, high alcohol,
151
treatment for Peptic Ulcers
depends on the cause, primarily with meds, antibiotics, blockage of acid production, antacids, protect the stomach lining.
152
dietary intervention with peptic ulcers,
individual tolerance.
153
when is gastric surgery necesaary
for stomach cancer, ulcers, or for weight loss
154
what is removed in gastric surgery
part or whole of stomach
155
what is the progression of
NPO, small amounts of liquid, liquid meals (no sugar), solid food 1/2 intro at a time, 5/6 small meals a day dpnd on stomach capacity.
156
the complication with gastric surgery
dumping (early/late)
157
what is dumping
a cluster of symptoms result from rapid emptying of osmatic load from the stomach to the small intestine,
158
early dumping
15-30 min after food, stomach empties too fast, hypersomatic stomach -- small intestine,
159
symptoms of early dumping
nausea, vomiting, cramping, diarrhea,
160
late dumping
1-3 hours after food, large insulin spike followed by rapid absorption of glucose, hyperglycemia.
161
symptoms of late dumping
anxiety, dizziness, confusion, sweating, weakness.
162
diet goal with dumping
slow down digestion, the lower osmolality of small intestine contents
163
diet changes with dumping
small freq meals, take fluid between meals, eat protein first, avoid sweets, soluble fibers, avoid lactose
164
dietary concerns with dumping
fat malabsorption, low amounts of vit D, and CA++, bone disease, anemia.
